Sunday, May 8, 2011

Amalga: Still Breathing?

With the recent selection of CSC, Microsoft, and HealthUnity by the MetroChicago Health Information Exchange, I’m once again intrigued with the role that Microsoft might play in the HIT market. I suspect the MetroChicago project is more interested in HealthVault, but Amalga is the most interesting product in Microsoft’s struggling healthcare vertical. Amalga is a strange and potentially very valuable product in the HIT market, but Microsoft needs to improve the way it positions the value statement to CIOs/CMIOs; and reduce the product’s Total Cost of Ownership.
Almaga’s origin in the ER as a tool for summarizing existing data in the healthcare enterprise is very evident in its current architecture and functionality. In that regard, Amalga functions very well as a read-only tool for existing transactions in systems such as LIS, RIS, and billing.
Interestingly, Amalga also provides a very solid data-analysis platform, somewhat similar in intent to a data warehouse. As a consequence, Amalga is equal parts transaction processing and analytic processing — which is potentially very powerful, especially to smaller healthcare organizations or “sometime later” adopters of EHRs who want to leverage existing data and transaction systems at the point of care, without necessarily buying into the current crop of semi-adequate EHRs.
If I were CIO for a small rural facility (or collaborative facilities) with limited budget, I would look strongly at Amalga as a first-step towards computerization of patient care. But, the first big drawback to this strategy is Amalga’s split personality for data collection at the point of care — orders, problems, medications, and progress notes are orphaned.
Achieving Meaningful Use with Amalga is going to be very difficult if not impossible, but I think one could argue that such implies a flaw in MU rather than Amalga. The other big drawback, of course, is the cost, which is historically outrageous and significantly driven by the large footprint in the data center. I’m told that in three prominent customer sites, Amalga was essentially a give-away sale, with Microsoft reaping value by way of brand association with noteworthy healthcare organizations.
I worked closely with Microsoft for a number of months while I was at Northwestern University, offering suggestions about product strategy and pricing models, in hopes that Northwestern might adopt the tool locally, but also in hopes that Amalga would succeed globally. I also advised several other organizations, mostly in the background, about their decision regarding Almalga — some of those organizations adopted, but the vast majority did not. In the end, we (Northwestern and Microsoft) couldn’t agree on a value proposition for Northwestern, which already had Cerner, Epic, and a data warehouse. There wasn’t any room or need for a product like Amalga.
In preparation for this blog, I asked Microsoft for an update on Amalga, but they declined, so I contacted several of the CIOs and other executives in organizations that adopted and didn’t adopt for their thoughts. I think Microsoft is a little tweaked because we didn’t choose the product at Northwestern, and also because I’m candid and open about Amalga’s weaknesses and Microsoft’s continued struggles to realize Amalga’s potential.
But, I’m also fair and open about its strengths. As a professional, I see in Amalga the potential for a new and better class of HIT tools which displace the traditional and often painfully complex and costly dyad of EHR and Data Warehouse. In Microsoft, I see an unfortunate inability to position, price and roadmap Amalga to unleash its potential, which could ultimately change the industry. In all sincerity, I’m cheering for the company to adjust its course because I believe it’s holding a game-changing product — at least conceptually. We need something better than the usual HIT products, and Amalga is definitely not the usual.

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